An Even Deadlier Opioid, Carfentanil, Is Hitting The Streets

First responders have found that standard doses of naloxone aren't always enough to counteract the powerful sedating effects of carfentanil.

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Originally published on September 2, 2016 4:54 pm

A powerful drug that's normally used to tranquilize elephants is being blamed for a record spike in drug overdoses in the Midwest. Officials in Ohio have declared a public health emergency, and the U.S. Drug Enforcement Administration says communities everywhere should be on alert for carfentanil.

The synthetic opioid is 100 times more potent than fentanyl, the prescription painkiller that led to the death earlier this year of the pop star Prince. Fentanyl itself can be up to 50 times more deadly than heroin.

In the past few years, traffickers in illegal drugs increasingly have substituted fentanyl for heroin and other opioids. Now carfentanil is being sold on American streets, either mixed with heroin or pressed into pills that look like prescription drugs. Many users don't realize that they're buying carfentanil. And that has deadly consequences.

"Instead of having four or five overdoses in a day, you're having these 20, 30, 40, maybe even 50 overdoses in a day," says Tom Synan, who directs the Hamilton County Heroin Coalition Task Force in Southwest Ohio. He's also the police chief in Newtown, Ohio.

Synan says carfentanil turned up in Cincinnati in July. At times, the number of overdoses has overwhelmed first responders.

"Their efforts are truly heroic, to be going from call to call to call," he says. "One district alone had seen 14 in one shift, so they were nonstop."

First responders and emergency room workers are being told to wear protective gloves and masks. That's because carfentanil is so potent, it can be dangerous to someone who simply touches or inhales it.

This was devastatingly clear back in 2002, after a hostage rescue operation in Moscow that went wrong. To overpower Chechen terrorists who'd seized control of a theater, Russian Special Forces sprayed a chemical aerosol into the building. More than 100 hostages were overcome and died. Laboratory tests by British investigators later revealed that the aerosol included carfentanil.

In Ohio, Hamilton County Health Commissioner Tim Ingram says it can take hours for the body to metabolize carfentanil, far longer than for other opiods. That means a longer-lasting high.

But it also means that when someone overdoses, it's more difficult to revive them — and save their life — with naloxone, the emergency medication used to block the effects of opioids.

"We've been getting lots of reports that they're using two or three doses to get people to come back," says Ingram. He's trying to distribute a more concentrated version of naloxone.

There is no approved human use for carfentanil. It's even highly restricted for veterinarians, who can use it lawfully to sedate large animals. The Drug Enforcement Administration says much of the carfentanil being sold on the streets is illicitly imported from China.

DEA spokesman Russ Baer says some of the illicit carfentanil is brought in by Mexican drug traffickers, then sold at huge profit since it only takes a granule or so to induce a high. He says carfentanil can also be bought online.

"You can go on the Internet and anybody can establish an anonymous account, and you can order carfentanil directly from China," he says.

Ingram foresees a turning point in illicit opioids. He wonders why anyone would go to the trouble of growing poppies in order to make heroin, when something much more powerful can be made in a lab.

"We may be seeing more and more synthetic opioids from this point forward," he says, "and we're going to have to prepare for it."

Synan thinks one shift should include tougher penalties. Generally, he says, selling drugs on the street is considered a nonviolent crime. But that may not make sense if the drug includes carfentanil.

"To me, that's just like pulling a gun out and shooting someone, because you know that a tiny bit can kill a person," Synan says. "To me, it's intentional. It's murder."

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STEVE INSKEEP, HOST:

Ohio has declared a public health emergency. It's a response to the latest phase of the opioid epidemic. NPR's Jennifer Ludden reports on a new drug that's being abused, a substance generally used to tranquilize elephants.

JENNIFER LUDDEN, BYLINE: The synthetic drug is called carfentanil. And here's how bad it is. It is 100 times more potent than fentanyl, the painkiller that led to the death of the pop star Prince. And fentanyl can be up to 50 times more deadly than heroin. Now, often unknown to addicts, carfentanil is being sold on American streets. It's either mixed into heroin or pressed into pills that look like prescription drugs.

TOM SYNAN: Instead of having four or five overdoses in a day, you're having these 20, 30, 40 - maybe even 50 - overdoses in a day.

LUDDEN: Police Chief Tom Synan directs the Hamilton County Heroin Coalition. He says carfentanil turned up in Cincinnati in July. And at times, the overdoses have overwhelmed first responders.

SYNAN: Their efforts are truly heroic - to be going from call to call to call. One district alone has seen 14 in one shift. So they were nonstop.

LUDDEN: Carfentanil is even dangerous to someone who simply touches or inhales it. First responders and emergency room workers are being told to wear protective gloves and masks. Hamilton County health Commissioner Tim Ingram says there's another challenge. Users stay high far longer than with other opioids.

TIM INGRAM: For the body to metabolize carfentanil, it takes about eight hours.

LUDDEN: That means when someone overdoses, it's more difficult to revive them to save their life with naloxone. That's the emergency medication used to block the effects of opioids.

INGRAM: Right now, we're actually looking to put a more concentrated version of naloxone on the streets because we've been getting lots of reports that they're using two or three doses to get people to come back.

LUDDEN: The U.S. Drug Enforcement Administration says carfentanil is coming from two places.

RUSS BAER: China and Mexico.

LUDDEN: DEA spokesman Russ Baer says Mexican drug traffickers see big profits, since it only takes a granule or so to induce a high. He says the carfentanil sold on streets is made in labs in China.

BAER: You can go on the internet. And anybody can establish an anonymous account. And you can order carfentanil directly from China. And we're seeing it shipped from China directly into the United States.

INGRAM: You know, it seems to me now that this might be a pivot point.

LUDDEN: Hamilton County health Commissioner Ingram says, why would anyone take the trouble to grow poppies in order to make heroin when something as powerful as this can be made in a lab?

INGRAM: We may be seeing more and more synthetic opioids from this point forward. And we're going to have to prepare for it.

LUDDEN: Ohio police Chief Tom Synan thinks that should include tougher penalties. Generally, he says, selling drugs on the street is considered a non-violent crime. But that may not make sense if the drug includes carfentanil.

SYNAN: To me, that's just like pulling a gun out and shooting someone because you know that a tiny bit can kill a person. So to me, it's intentional. It's murder.

LUDDEN: It can take months to identify a drug. But carfentanil is suspected in overdose spikes across the Midwest and in Florida. The DEA says communities everywhere should be on alert. Jennifer Ludden, NPR News. Transcript provided by NPR, Copyright NPR.